Objectives: Rheumatoid arthritis (RA) is strongly associated with cardiovascular morbidity
and mortality. Previous studies have demonstrated that TNFα-inhibitors may reduce cardiovascular
events (CVE) in patients with RA. Thus, the purpose of this systematic review was to evaluate the
ability of TNFα-inhibitors to reduce the risk of CVE in patients with RA. This study will update the
findings of two earlier systematic reviews that synthesized the data up until 2010.
Methods: A search of Medline, Embase, Medline In-Process and Other Non-Indexed Citations,
American College of Physicians Journal Club, Database of Abstracts of Reviews of Effects, and the
Cochrane Central Register of Controlled Trials was conducted for observational studies reporting on
CVE in RA patients since 2009. Conference proceedings for the Canadian Rheumatology Association,
American College of Rheumatology, and European League against Rheumatism were also
searched between 2009 and 2014. Abstracts were assessed for inclusion by two reviewers and studies
identified by either reviewer were brought forward to full-text review. Studies undergoing full-text
review were further assessed based on predefined inclusion and exclusion criteria and the quality of
selected papers was evaluated using the Newcastle-Ottawa Scale.
Results: The search identified 6089 abstracts and 14 articles were included in the final systematic
review. Of the studies included, 8 reported on the effect of TNFα-inhibitors on overall CVE, 10 reported
on coronary artery disease (CAD), 6 reported on cerebrovascular disease (CVD), and 5 reported
other clinical cardiovascular outcomes.
Conclusion: TNFα-inhibitors appear to reduce the likelihood of overall CVE in individuals with RA.
The reduction is not as pronounced in the individual outcome measures. These results are consistent
with two previous systematic reviews suggesting that TNFα-inhibitors are likely useful in the prevention
of cardiovascular complications of RA.